title: Continuous regional arterial infusion for acute pancreatitis: a propensity score analysis using a nationwide administrative database.
abstract: BACKGROUND
  Although continuous regional arterial infusion (CRAI) of a protease inhibitor and an antibiotic may be effective in patients with severe acute pancreatitis, CRAI has not yet been validated in large patient populations. We therefore evaluated the effectiveness of CRAI based on data from a national administrative database covering 1,032 Japanese hospitals.
  
  
  METHODS
  In-hospital mortality, length of stay and costs were compared in the CRAI and non-CRAI groups, using propensity score analysis to adjust for treatment selection bias.
  
  
  RESULTS
  A total of 17,415 eligible patients with acute pancreatitis were identified between 1 July and 30 September 2011, including 287 (1.6%) patients who underwent CRAI. One-to-one propensity-score matching generated 207 pairs with well-balanced baseline characteristics. In-hospital mortality rates were similar in the CRAI and non-CRAI groups (7.7% vs. 8.7%; odds ratio, 0.88; 95% confidence interval, 0.44-1.78, P = 0.720). CRAI was associated with significantly longer median hospital stay (29 vs. 18 days, P < 0.001), significantly higher median total cost (21,800 vs. 12,600 United States dollars, P < 0.001), and a higher rate of interventions for infectious complications, such as endoscopic/surgical necrosectomy or percutaneous drainage (2.9% vs. 0.5%, P = 0.061).
  
  
  CONCLUSIONS
  CRAI was not effective in reducing in-hospital mortality rate in patients with acute pancreatitis, but was associated with longer hospital stay and higher costs. Randomized controlled trials in large numbers of patients are required to further evaluate CRAI for this indication.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamada
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use*; D007261:Infusions, Intra-Arterial; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000188:drug therapy*; D057216:Propensity Score; D011480:Protease Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011480:Protease Inhibitors; D015378:Imipenem